Events...

I haven't posted in two weeks.  I really haven't done anything except work... no rides, the insights and observations I have had weren't worth posting, and about the only thing to note is that I renewed or extended my current contract.  Pretty uneventful, that is until last night...

In previous posts I explained the CDU (Clinical Decision Unit), well I was assigned there last night with two other nurses as there were ten patient's.  Two of us had three patient's each, the third had four.  Well, the two of us who had three patients, each ended up discharging to home one patient and fully admitting one patient.  So we each now only had one patient.  That was quickly resolved within a few hours, as several more patients were admitted to the CDU.

So far, pretty uneventful.  When my peer received her third admit around 11:30pm - a patient that reportedly had a seizure at home, brought to the ED, monitored for several hours, and finally the decision was made to keep the patient "overnight."  Now the patient had no further seizure activity while in the ED for the past 12+ hours.  The patient arrives, my peer goes down to start the process of admission to the unit.  The other nurse and I were sitting at the nursing station, reviewing charts, documenting, etc. when not 5 minutes later our peer walks calmly into the nursing station and says that her new patient was actively seizing.  We asked her if she needed any help and she replied, "umm... sure."

So as she is accessing medication to stop the seizure, the other nurse and I walk down to the room.  Yep!  They were seizing... full-blown, tonic-clonic, full body seizure!  Pretty scary thing to see for the first time, as was evidenced by the spouse standing at the foot of the bed wide-eyed, mouth open, staring...  As my peer turned the patient on their side, I hooked up and turned on the suction handing it to her so she could clear the patient's airway.  I then hooked up an oxygen mask and placed it on the patient.  Our third finally arrived with the medications, administered them, and within 45 seconds to a minute, the seizure stopped.  We monitored the patient until they started to regain consciousness, reassured the spouse that their loved one was OK, and finally left the room giving the spouse instructions to press the call light if the patient began seizing again or if they felt anything was wrong.  About 15 minutes total had elapsed since my peer came into the nursing station advising us of the situation.

The patient's nurse immediately put a page out to the admitting physician.  While waiting for a callback, she called the ED Clinical Leader (Supervisor) to inform them that the patient had had a seizure and is not appropriate for an Observation Unit and needs to be admitted to an inpatient bed.  About 3 minutes later, in comes the ED Supervisor, closely followed by the ED Attending, then between 3 and 5 ED Residents (hard to tell as they tend to move in packs trying to jostle to be the first one in the room behind the Attending to get a prime position), followed by the ED Pharmacist and a Respiratory Therapist!  And they all looked at the three of us, four actually as the Patient Care Tech (PCT) we had on the Unit was there, sitting rather nonchalantly at the nursing station.

Once they passed, the four of us just looked at each other and someone asked, "Why the 'Rapid Response Team'?"  Well, a few minutes later out come the 5 residents (yes, the tend to walk in pairs or singly when not in a rush), the pharmacist, and RT.  The supervisor and the Attending stop at the nursing station to ask what happened.  When my peer explained what was observed, what our treatment had been, and the patient's response, the Attending nodded and said, "Good job," then left.  The ED supervisor stayed and admitted that they were a little perplexed to see the four of us sitting at the nursing station like nothing happened when they came in.  I responded, "The patient had a seizure, all four of us are highly skilled and experienced ED staff - it happened, we responded, we did, we fixed, we left!"  She smiled, and chuckled.  I continued, "Sometimes doctors get in the way of getting things done, it's best to call them and tell them what happened after one fixes the problem."  This time she laughed.

The patient was quickly admitted and transferred to an inpatient bed.  And the rest of the shift was uneventful...

When another patient... at 06:52am... a mere 18 minutes before shift change...


Well, that's another story, and since this post is getting long, you'll just have to come back tomorrow to read about it!